Where 'pill mill' problem meets medical marijuana push

Crackdown on 'pill mills' puts genuine pain patients in a hard spot. Could medical marijuana be a solution to some of the suffering?

By DONNA KOEHN

It might be the agony of bone cancer, a spine mangled by an auto accident, or unrelenting diabetic neuropathy.

It also could be the misery of Lou Gehrig’s disease, which led Parrish’s Cathy Jordan to use marijuana to make her days bearable. She was in the news last week when law enforcement officers, some in ski masks, raided her home over some marijuana plants.

Chronic pain can be a torment, driving some patients into clinical depression and even suicide. Many will try anything to find relief.

But marijuana is illegal here, and, in a state zealously working to shut down its so-called “pill mills,” legitimate pain sufferers are finding it increasingly hard to find relief.

“Patients are ostracized and criminalized,” said Paul Sloan, who runs two pain management clinics in Sarasota and Fort Myers. “There’s a complete war on these suffering people.”

Sloan helped develop Florida’s prescription drug registry in 2011; doctors use it to see if the patient on the exam table asking for pain relief is instead making the rounds to build up a stash of highly addictive oxycodone or Vicodin.

Such seekers are the true targets of the crackdown, along with pharmacists and doctors who write and dispense prescriptions without checking anything on a patient but the depth of his or her financial wherewithal.

But what began as a legitimate attempt to erase Florida’s embarrassing reputation as the epicenter of the nation’s prescription drug epidemic has backfired, Sloan said.

“If you are a new patient trying to get your first prescription filled, you might as well move out of the state,” he said. “It helps if the pharmacist knows you.”

Even big pharmacy chains are under scrutiny by the U.S. Drug Enforcement Administration.

When the state began closing down the pill mills, some of their legitimate customers turned to chain pharmacies and mom-and-pop drug stores.

The jump in prescriptions filled at these pharmacies triggered even more raids — on them.

Last April, the DEA inspected six Walgreens pharmacies in Florida, including ones in Hudson, Port Richey, Fort Myers and Fort Pierce, as well as its state distribution center.

In September, the DEA called the distribution center an “imminent danger to the public safety” for failing to better control distribution of oxycodone and other controlled substances.

“All DEA registrants have an obligation to ensure that medications are getting in the hands of legitimate patients, and when they choose to look the other way, patients suffer and drug dealers prosper,” said DEA Special Agent in Charge Mark R. Trouville.

Robert Florio, a Sarasota pain management specialist, says some patients began coming to him in tears because they could not find anyone willing to fill their prescriptions.

“Some of these people don’t have easy access to pharmacies or easy transportation,” Florio said. “Some of them have trouble ambulating from pharmacy to pharmacy because of pain.”

Some drug stores began raising the price of pain medications due to supply and demand, Florio said

“Many patients have become very stressed and depressed over this,” he said.

Both physicians say their patients are too frightened to speak up, fearing backlash by the DEA or local law enforcement.

When Sloan’s patients began to report that Walgreens had refused to fill their prescriptions, he asked a pharmacist there why.

He was told the chain has a “secret policy” to decide who will get pain medication and who will not.

“You know, not all of these patients wear suits and drive nice cars,” Sloan said. “Some of them are out of work because of their injuries.”

He was recently at a Walgreens store in Venice when a longtime customer was handed a prepared statement.

It read: “Walgreens is working hard to ensure the safe dispensing of controlled pain medications. Based on my clinical review and professional judgment, the prescription does not meet the requirements we have put into place for dispensing these medications. Therefore we cannot fill this prescription in good faith at this or any other Walgreens. I apologize for any inconvenience.”

When Sloan asked the pharmacist what the rules were, the pharmacist replied that they were secret but developed with the help of the DEA.

Jim Graham, spokesman for Walgreens corporate offices in Illinois, said he could not speak about these incidents without knowing the specifics.

However, he said by email, “Part of the professional role of a pharmacist has always included determining whether the prescription was issued for a legitimate medical purpose and whether it can be filled in good faith.

“That role also has always included the ability to decline filling a prescription that the pharmacist determines to be outside the usual course of professional practice,” Graham said.

Sloan said some of his patients have reported feeling humiliated about going to the hospital in pain, sensing they are under immediate suspicion as drug addicts.

North Port’s Joseph Majorino, 48, fell from a roof while on a construction job in 2007. The pain in his feet and ankles continues to be excruciating.

He now takes Vicodin every day, finding oxycodone too strong and other drugs too weak.

“I’m always looking over my shoulder,” Majoriono said. “Even though I cut back on the Vicodin if I have to drive, I worry that if I’m pulled over for something, the cop will arrest me.”

In an effort to help some Floridians in pain, legislators are introducing a bill, named for Cathy Jordan, to join the 18 states that already have made marijuana legal for medical purposes.

Although polls show the idea is growing in acceptance nationwide, some don’t believe marijuana is the panacea for those in pain.

In a February article in The New England Journal of Medicine, Gary Reisfield, chief of pain medicine in the department of psychiatry at the University of Florida, wrote that pot isn’t medicine and shouldn’t be used in that way.

“Simply to allow a patient with uncontrolled symptoms of metastatic breast cancer to leave the office with a recommendation to smoke marijuana is to succumb to therapeutic nihilism,” he wrote.

In a counterpoint article, Michael Bostwick, a psychiatrist at the Mayo Clinic in Minnesota, said that federal policy has not kept pace with scientific advances, and that “largely anecdotal but growing literature supports” the efficacy of marijuana for pain and nausea that do not respond to ordinary treatments.

Florida’s Republican-dominated Legislature is unlikely to approve the medical marijuana bill, at least not on this first go-round. But if it passes, some patients say they will try marijuana and dump their legally prescribed pain medication.

Joan Marino Maser says she suffers from a number of physical problems.

“I live in extreme pain,” she wrote in the online comments section on the Herald-Tribune’s website, following a story on Jordan’s situation. “I fall all the time and I keep getting worse, not better. Smoking a little marijuana would be a lot easier on my body than the 30-plus pills I take.”

An advocacy group in support of medical marijuana conducted a poll that said 70 percent of voters supported this use.